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“It’s dramatic,” says Christopher Murray, who heads the Institute for Health Metrics and Evaluation at the University of Washington. He helped conduct the analysis, published Tuesday in JAMA Internal Medicine.

Health experts have long known that Americans living in different parts of the country tend to have different lifespans. But Murray’s team decided to take a closer look, analyzing records from every U.S. county between 1980 and 2014.

“What we found is that the gap is enormous,” Murray says. In 2014, there was a spread of 20.1 years between the counties with the longest and shortest typical lifespans based on life expectancy at birth.

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